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South Dakota rates for HCPCS 15736

Muscle, myocutaneous, or fasciocutaneous flap; upper extremity

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,155.09 / $1,155.09 / $3,511.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,451.99 / $2,000.00 / $3,414.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,716.91 / $2,600.52 / $3,211.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.85 / $2,086.90 / $2,379.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00